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Meconium is the first stool of a newborn baby, greenish‐black in colour and rather sticky in consistency. If a baby is distressed before birth meconium may be passed into the amniotic fluid and if the baby then gasps the meconium‐stained fluid may pass into the lungs. Once in the lungs the meconium can make the baby ill by obstructing the airways and causing inflammation this is called meconium aspiration syndrome. It is possible to reduce the amount of meconium getting into the lungs by sucking it from the baby’s throat and windpipe (trachea) soon after birth but it is not certain if this leads to overall benefit for the vigorous term newborn baby. Furthermore, placing a tube in the windpipe (endotracheal intubation) of a vigorous term baby is not always easy and could cause harm. Four studies enrolled 2844 term infants and randomly allocated them to intubation to clear the airways or routine resuscitation without intubation. No benefit was found from routine intubation compared to routine resuscitation for vigorous term babies. The outcomes reported included: meconium aspiration syndrome, lung air leaks, need for oxygen, noisy breathing (stridor) and fits but there were no significant differences between the two groups. Routine endotracheal intubation of vigorous term babies born through meconium‐stained amniotic fluid cannot be recommended. For non‐vigorous babies endotracheal intubation is probably indicated until more information becomes available.

become severely depressed, so rapidly providing effective ventilation in the delivery room is very important. Ventilation is often started using a bag with oxygen attached, that is manually pumped (manual resuscitation bag) to force air into a close‐fitting face mask held over the infant's nose and mouth. If breathing remains depressed after using the manual resuscitation bag, a tube is placed directly into the infant's large airway (endotracheal intubation). Bag and mask ventilation and endotracheal intubation may not be possible when infants have airway obstructions or head and face abnormalities, obstructing the normal flow of air through the nose and mouth into the lungs and obstructing the view of the airway by the medical personnel attempting intubation. The laryngeal mask airway is an alternative to bag and mask ventilation and endotracheal intubation that uses a small mask attached to the end of a silicone tube, which can be fitted into the throat to provide positive pressure ventilation into the airway. The review authors made a thorough search of the medical literature and found one, small randomized trial (with 40 infants) that compared the laryngeal mask with endotracheal intubation, when bag and mask ventilation had been unsuccessful. There was no clinical difference between the two methods. Overall, the time taken to insert both devices was very short (7.5 to 10 sec) and the resuscitators had a very high first time success rate. No eligible randomized studies compared the laryngeal mask with bag and mask ventilation.

Acute illness and injury are the most common causes of death and disability worldwide in people aged under 50 years. The highest priority in an emergency is to enable a patient to breathe by securing their airway (passage from the nose and mouth into the lungs). Endotracheal intubation is one of various ways to secure the airway. This review found no difference between endotracheal intubation and other airway securing strategies for reducing deaths after acute illness or injury; however, better studies are needed.

There is no evidence from trials about the optimum depth for catheter insertion when suctioning clear the endotracheal tube in babies in neonatal intensive care. Babies in neonatal intensive care often need mechanical ventilation to assist breathing. This involves inserting an endotracheal tube (ETT) down the baby's windpipe so that a machine ventilator can help the baby breathe. Lung secretions can build up in the tube and cause blockages. Build‐up is minimized by suctioning the ETT clear with a catheter (small tube). One of the variations of technique possible for suctioning is depth of catheter insertion into the ETT. However, the review found no trials to show what depth of insertion of catheter into the endotracheal tube gains optimal clearance without damaging the baby's lungs.

There is no evidence that time on endotracheal CPAP (continuous low pressure rather than intermittent breaths from the ventilator) before taking preterm babies off a ventilator helps them adjust to breathing on their own. Babies in neonatal intensive care often need help to breathe, sometimes via an endotracheal tube (through the windpipe) connected to a mechanical ventilator. It was thought that it might help a baby adjust to breathing after ventilation if there was a period of CPAP (continuous positive airways pressure) before extubation (coming off the ventilator). However, there have also been concerns that this may create too much work for the baby, and may cause harm. This review found that a trial of CPAP before extubation does not improve the baby's ability to breathe on their own.

Doxapram has not been shown to improve outcomes for babies being weaned off mechanical breathing support.When preterm babies have been on mechanical breathing support in neonatal intensive care, it can be hard to wean them off the machine (tracheal extubation). Using drugs called methylxanthines, or breathing support via the nose (nasal CPAP ‐ continuous positive airways pressure) can help. Doxapram stimulates breathing, and is another drug that is sometimes used around extubation. However, the review of trials found no evidence that doxapram can reduce problems for babies around extubation, and it may cause some adverse effects. Further research is needed.

In emergency situations some people need a general anaesthetic with an endotracheal tube (a tube to help them breathe). It is important to have fast‐acting medications to allow physicians to complete this procedure quickly and safely. Currently, the medication used most frequently to relax muscles is succinylcholine. Succinylcholine is fast‐acting and lasts for only a few minutes, which is very desirable in this setting. However, some people cannot use this medication as it can cause serious salt imbalances or reactions, so an equally effective medication without these side effects would be advantageous. One possible alternative medication is rocuronium, a muscle relaxant with fewer side effects but longer duration of action. This review compares the quality of intubation conditions (the ease with which physicians can quickly and safely pass the endotracheal tube) between rocuronium and succinylcholine in all ages and varying clinical situations.

There is not enough evidence to demonstrate any differences in the effect of nasal versus oral intubation for mechanical ventilation of newborn babies in neonatal intensive care. Babies in neonatal intensive care often need help to breathe, sometimes via a ventilator (machine). Air is mechanically pumped into their lungs through a tube that is either inserted into their mouth or nose (endotracheal intubation). Insertion can fail and problems can include a blockage in the tube or the baby's airway, the wrong size tube or injury as a result of the presence of the tube. Complications caused by endotracheal intubation can also have serious adverse effects for the baby such as heart and breathing problems. The review did not find enough evidence from trials to demonstrate any differences in the effect of nasal versus oral intubation. More research is needed.

People who are critically ill often need help breathing. One way to do this is called endotracheal intubation. This involves placing a tube into the windpipe (trachea) and having a ventilator (breathing machine) help the patient breathe.

Hospitalized patients are often at increased risk for oropharyngeal dysphagia following prolonged endotracheal intubation. Although reported incidence can be high, it varies widely. We conducted a systematic review to determine: (1) the incidence of dysphagia following endotracheal intubation, (2) the association between dysphagia and intubation time, and (3) patient characteristics associated with dysphagia. Fourteen electronic databases were searched, using keywords dysphagia, deglutition disorders, and intubation, along with manual searching of journals and grey literature. Two reviewers, blinded to each other, selected and reviewed articles at all stages according to our inclusion criteria: adult participants who underwent intubation and clinical assessment for dysphagia. Exclusion criteria were case series (n < 10), dysphagia determined by patient report, patients with tracheostomies, esophageal dysphagia, and/or diagnoses known to cause dysphagia. Critical appraisal used the Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development and Evaluation tools. A total of 1,489 citations were identified, of which 288 articles were reviewed and 14 met inclusion criteria. The studies were heterogeneous in design, swallowing assessment, and study outcome; therefore, we present findings descriptively. Dysphagia frequency ranged from 3% to 62% and intubation duration from 124.8 to 346.6 mean hours. The highest dysphagia frequencies (62%, 56%, and 51%) occurred following prolonged intubation and included patients across all diagnostic subtypes. All studies were limited by design and risk of bias. Overall quality of the evidence was very low. This review highlights the poor available evidence for dysphagia following intubation and hence the need for high-quality prospective trials.

INTRODUCTION: Endotracheal intubation (ETI) is currently considered superior to supraglottic airway devices (SGA) for survival and other outcomes among adults with non-traumatic out-of-hospital cardiac arrest (OHCA). We aimed to determine if the research supports this conclusion by conducting a systematic review.

INTRODUCTION: Endotracheal intubation (ETI) is currently considered superior to supraglottic airway devices (SGA) for survival and other outcomes among adults with non-traumatic out-of-hospital cardiac arrest (OHCA). We aimed to determine if the research supports this conclusion by conducting a systematic review.

INTRODUCTION: The Glidescope(®) video-laryngoscopy appears to provide better glottic visualization than direct laryngoscopy. However, it remains unclear if it translates into increased success with intubation.

Continuous positive airway pressure (CPAP) provides extra gas flow through the nose and thereby helps keep the lung properly inflated. This helps reduce breathing problems in preterm babies after the tube used to assist breathing is removed from their windpipe. Preterm babies (babies born before 37 weeks) may need help to breathe properly. Sometimes this is given via a tube placed into the windpipe, through the mouth or nose, to give oxygen from a machine (mechanical ventilation). This method helps restore breathing but when the tube is removed (this process of removal is called extubation), breathing problems can occur. Nasal continuous positive airways pressure (NCPAP) provides extra gas flow through the nose and thereby helps keep the lung properly inflated. The review of trials found NCPAP is effective in preventing failure of extubation after a period of mechanical ventilation.

Non‐invasive positive pressure ventilation (NPPV) enhances breathing in acute respiratory conditions by resting tired breathing muscles. It has the advantage that it can be used intermittently for short periods, which may be sufficient to reverse the breathing problems experienced by patients during severe acute asthma. We undertook this review to determine the effectiveness of NPPV in patients with severe acute asthma. Six randomised controlled trials were included in the review. Compared to usual medical care alone, NPPV reduced hospitalisations, increased the number of patients discharged from the emergency department, and improved respiratory rate and lung function measurements. The application of NPPV in patients with asthma, despite some promising preliminary results, still remains controversial. Further studies are needed to determine the role of NPPV in the management of severe acute asthma and especially in status asthmaticus.

The evidence is current to October 2013. We included 19 randomized controlled trials (1940 participants) in this updated review. (We reran the search in February 2015 and found four studies of interest. We will deal with those studies when we next update the review.) Lidocaine was either put into the cuff (the cuff makes sure that the tube stays in place), sprayed onto the person's vocal cords, or used as a gel smeared on the end of the tube.

Dexamethasone may help babies at high risk of complications when being taken off mechanical breathing support. The tube that is placed in the baby's airway to enable mechanical ventilation (machine‐assisted breathing) can cause injury. This can lead to complications when the tube is removed (extubation). This review found that giving dexamethasone (a corticosteroid drug) around the time of extubation can help prevent swelling in the baby's throat that might require reinsertion of the tube. However, the review found that there are adverse effects of dexamethasone. The benefits only outweigh the risks for babies at high risk of complication (such as those who have received several, or prolonged, intubations).